4种带蒂皮瓣修复35例累及口角的颊部洞穿性缺损效果比较

doi:10.19438/j.cjoms.2021.02.004

中国口腔颌面外科杂志 ›› 2021, Vol. 19 ›› Issue (2): 116-120.doi: 10.19438/j.cjoms.2021.02.004

4种带蒂皮瓣修复35例累及口角的颊部洞穿性缺损效果比较

洪磊, 陈伟良, 袁开放, 周斌, 陈睿

中山大学孙逸仙纪念医院口腔颌面外科, 广东广州 510120

收稿日期:2020-03-23 修回日期:2020-07-16 出版日期:2021-03-20 发布日期:2021-05-11
通讯作者: 陈伟良,E-mail: drchen@vip.163.com
作者简介:洪磊（1993-）,男,在读硕士研究生,E-mail: honglei@mail2.sysu.edu.cn
基金资助:
国家自然科学基金( 81772888)

Comparison of reconstruction outcomes of through-and-through buccal defects involving the labial commissure following tumor resection with 4 pedicled local flaps

HONG Lei, CHEN Wei-liang, YUAN Kai-fang, ZHOU Bin, CHEN Rui

Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. Guangzhou 510120, Guangdong Province, China

Received:2020-03-23 Revised:2020-07-16 Online:2021-03-20 Published:2021-05-11

摘要/Abstract

摘要： 目的比较4种带蒂皮瓣修复累及口角的颊部洞穿性缺损的效果。方法 35例累及口角的颊部鳞状细胞癌患者行根治性切除术后,采用4种带蒂皮瓣进行修复重建,4种皮瓣分别为交叉唇瓣（A-EF）、折叠延长锁骨上岛状皮瓣（SFIF）、折叠胸大肌肌皮瓣（PMMF）和折叠延长下斜方肌岛状皮瓣（TIMF）。比较4组患者修复重建后的效果,结果采用SPSS 20.0软件包进行统计学分析。结果从美学角度,口轮匝肌功能以及发音功能比较,A-EF组显著优于其他3组（P<0.05）。在最后的随访中,A-EF组4例患者（80.0%）、SFIF组7例患者（87.5%）、PMMF组5例患者（55.6%）、TIMF组5例患者（38.4%）无严重术后并发症并存活;A-EF组1例患者（20.0%）、SFIF组1例患者（12.5%）、PMMF组2例患者（22.2%）、TIMF组4例患者（30.8%）带瘤生存;PMMF组2例患者（22.2%）和TIMF组4例患者（30.8%）于术后9~38个月分别死于原发灶复发或远处转移。结论 A-EF更适于临床Ⅱ期肿瘤术后缺损的修复重建;SFIF更适于临床Ⅱ期或Ⅲ期肿瘤患者;PMMF更适于临床Ⅲ期或Ⅳ期肿瘤患者;TIMF更适于临床Ⅲ期或Ⅳ期肿瘤患者。

关键词: 颊部, 鳞状细胞癌, 颊部缺损, 带蒂皮瓣, 交叉唇瓣, 延长锁骨上皮瓣, 胸大肌肌皮瓣, 下斜方肌肌皮瓣

Abstract: PURPOSE: The purpose of this study was to evaluate the outcomes of reconstruction of through-and-through buccal defects involving the labial commissure following tumor resection with 4 pedicled local flaps. METHODS: This study evaluated 35 patients with buccal squamous cell carcinoma(SCC) involving the labial commissure who received Abbe-Estlander (A-EF), folded extended supraclavicular fasciocutaneous island(SFIF), folded pectoralis major muscle (PMMF), or folded extended vertical lower trapezius island myocutaneous(TIMF) flap for reconstruction of through-and-through buccal defects. The results were analyzed with SPSS 20.0 software package. RESULTS: The A-EF and SFIF group differed significantly (P<0.05) from the PMMF and TIMF groups in terms of tumor clinical stage and type of treatment. The esthetic results, orbicularis oris function, and speech function were significantly better in A-EF group than in SFIF, PMMF, and TIMF group(P<0.05). At the final follow-up, 4(80.0%) patients in A-EF group, 7(87.5%) in SFIF group, 5 (55.6%) in PMMF group, and 5(38.4%) in the TIMF group were alive with no disease; one (20.0%), 1(12.5%), 2(22.2%), and 4(30.8%) patients, respectively, were alive with disease, and 2(22.2%) patients in PMMF group and 4(30.8%) in TIMF group died of local recurrence or distant metastases between 9 and 38 months. CONCLUSIONS: A-EF is suitable for reconstructing defects of clinical stage Ⅱ disease, SFIF for clinical stage Ⅱ or Ⅲ disease, PMMF for clinical stage Ⅲ or Ⅳ, and TIMF for clinical stage rCS Ⅲ or rCS Ⅳ disease.

Key words: Cheek, Squamous cell carcinoma, Buccal defect, Pedicled local flaps, Abbe-Estlander flap, Supraclavicular flap, Pectoralis major muscle flap, Trapezius myocutaneous flap

中图分类号:

R782.2

洪磊, 陈伟良, 袁开放, 周斌, 陈睿. 4种带蒂皮瓣修复35例累及口角的颊部洞穿性缺损效果比较[J]. 中国口腔颌面外科杂志, 2021, 19(2): 116-120.

HONG Lei, CHEN Wei-liang, YUAN Kai-fang, ZHOU Bin, CHEN Rui. Comparison of reconstruction outcomes of through-and-through buccal defects involving the labial commissure following tumor resection with 4 pedicled local flaps[J]. China J Oral Maxillofac Surg, 2021, 19(2): 116-120.

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4种带蒂皮瓣修复35例累及口角的颊部洞穿性缺损效果比较

Comparison of reconstruction outcomes of through-and-through buccal defects involving the labial commissure following tumor resection with 4 pedicled local flaps

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